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Long Range Strategy Plan ORBIS INTERNATIONAL INDIA

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Title: Long Range Strategy Plan ORBIS INTERNATIONAL INDIA


1
Long Range Strategy PlanORBIS INTERNATIONAL
INDIA
  • Highlights of the Situational Analysis Document
  • Keerti Bhusan Pradhan,
  • B R Shamanna,
  • P K Nirmalan

2
This situational analysis document is a draft
document subject to revision finalization after
the deliberations in this workshop. The document
aims to provide a framework for discussion to
guide the initiatives of ORBIS India eye care
program
3
Purpose Methods
  • Main Purpose
  • To drive ORBIS India country offices direction
    in the eye care milieu of the country.
  • Methodology
  • Primary Secondary information
  • Discussions
  • Analysis by the consultants based on their
    experience

4
GLOBAL BLINDNESS
Millions
50
45
38
31
? 30
28
1975
1980
1984
1990
1995
2000
5
Prevalence of Blindness (Visual Acuity lt6/60) as
per the National Survey (86-89)  
6
Blindness in South East Asia
  • Prevalence 0.8 Range 0.3 1.5
  • Cataract Major Cause, 50-80
  • Other major causes uncorrected refractive
    errors, trachoma, childhood blindness, corneal
    blindness, ocular trauma.
  • Cost of Blindness US 5.6 billion annually

7
Profile of SEA Region
  • 25 of the worlds population
  • 33 of the worlds blind
  • 40 of the worlds poor
  • 50 of the worlds childhood blindness
  • 60 of the cataract backlog

8
Others
Cornea
Cataract
Glaucoma
Ref.error
9
  • Eye Care Service Delivery in India
  • About 65 of surgical performance in the country
    is performed in the private and voluntary sector
    and only 35 is within the government sector.
  • About 11,000 ophthalmologists and an equal number
    of trained and recognized mid level personnel
    (MLP) exist as opposed to the ratio of having at
    least 4-5 MLP for each ophthalmologist. 50 of
    the ophthalmologists are surgically inactive
    within the country.
  • The ophthalmologist to population ratio in urban
    India is 125,000 but in rural India it is about
    1250,000.

10
Eye Care Service Delivery in India
Rapid assessment surveys in 14 districts in the
country - coverage at 70 IOL surgery increased
to 60 Poor surgical outcomes, as high as 40
post-operatively blind following conventional
ICCE 10 following IOL surgery population
based outcomes
11
Current situation - India
  • Reasonable facilities and service delivery
    mechanisms that can be utilized.
  • Demographic and epidemiological transitions
    increase and change in disease patterns despite
    current intervention levels.
  • Unifocal vertical interventions limited
    structure at the community level.
  • Need for more public-private coordination efforts
    in eye care in India

12
Disease Control Status
  • Cataract
  • Issues
  • Major cause for blindness
  • Changing demographics Increasing prevalence and
    incidence
  • Only 60 IOL
  • Quality of surgery

13
Disease Control Status
  • Cataract
  • Issues
  • Geographic coverage
  • Socioeconomic issues
  • Gender issues

14
Disease Control Status
  • Cornea
  • Issues
  • Infectious disease
  • Nutritional causes
  • Trauma
  • Awareness, treatment strategies and access
  • Determining the national need for corneas

15
Disease Control Status
  • Cornea
  • Issues
  • Eye banking
  • Availability of grafts, Capability to graft
  • Preservation of graft material
  • Standardized protocols, accreditation need for
    appropriate legislation
  • Awareness of eye donation (gap between pledge and
    actual donation)

16
Disease Control Status
  • Childhood blindness estimate 1.5 million
  • Issues
  • Almost 50 of childhood blindness in India
  • Overshadowed by the cataract problem
  • Limited epidemiological details
  • Cause estimates mainly from blind school data

17
Disease Control Status
  • Childhood blindness
  • Issues
  • No service delivery models
  • Few pediatric Ophthalmology Units
  • Cost effectiveness of service delivery
  • Pediatricians and primary care personnel not
    involved

18
Disease Control Status
  • Refractive errors
  • Issues
  • Uncorrected refractive errors being recently
    recognized as a problem
  • 60-70 of refractive errors can be corrected by
    spectacles
  • Accessible, affordable, available spectacles
  • Need for service delivery models including
    follow-up

19
Disease Control Status
  • Low Vision
  • Issues
  • Low appreciation of need even among eye care
    professionals
  • Few Centres trained personnel
  • Cost of devices
  • Availability acceptability of devices

20
Disease Control Status
  • Emerging problems
  • Diabetic Retinopathy
  • Glaucoma
  • Age Related Macular Degeneration

21
Human resources
  • 11,000 Ophthalmic surgeons
  • Paramedical staff 15,000
  • 15,000 to 20,000 persons in eye care without any
    formal training and qualification

22
Human resources
  • 80 institutions currently training MLOPs in
    India
  • 1300 persons each year
  • Fellowship programs
  • Optometry, Ophthalmic techniques, Instrument
    maintenance, opticians, management courses

23
Human Resources status
and needs in India  
24
Major Issues in Blindness Control in India
  • Limited levels of coordination among Private,
    Voluntary Public Sectors
  • Emphasis on Quantity over Quality
  • Excessive reliance on camps and improvised
    facilities previously did not translate into
    expected permanent solutions
  • Mismatch in Infrastructure, human resources
    limited training
  • Programs unable to redress barriers at the
    community level

25
India Vision 2020 Plan of Action
  • Revamping of medical Education
  • Redeployment of human resources
  • Better coordination among all stakeholders
  • Better service quality standards protocols
  • Due emphasis on preventive eye care
  • Strengthen advocacy
  • Reduction of disease burden
  • Strengthen physical infrastructure and human
    resources
  • MIS for better program management
  • Central government Advisory role in Policy,
    resource mobilization and program implementation

26
Targets 2002 2007 (India Vision 2020)
  • Increase CSR to 4,500 by 2005
  • 80 operated cases good outcomes
  • Increase IOL surgeries to more than 80
  • Establish at least 50 pediatric eye units
  • Opportunistic high risk screening for glaucoma
    and diabetic retinopathy
  • Establish 7,500 more vision centres, 50 more
    training centres, 325 more service centres 7
    more centres of excellence for eye care service
    delivery.
  • Integrate components of PEC in PHC and training
    in PEC
  • 25 fully accredited eye banks, 50 new low vision
    centres and 20 eye donation centres and
    networking

27
Eye Care in the Broader Health Care Agenda of the
country
  • National Health Policy 2002 Reduction of
    prevalence of blindness to 0.5 by 2010
  • Establishment of a baseline data for incidence of
    blindness by 2005
  • Use data for Evidence Based Policy
  • Mapping of facilities and infrastructure on a
    country level for comprehensive service delivery
    approach.
  • Statutory professional council for paramedical
    personnel

28
Role of Stakeholders in Eye Care in India
  • Multilateral Bilateral agencies
  • WHO
  • World Bank
  • UNICEF
  • DANIDA (DANPCB)
  • DFID
  • USAID

29
Role of Stakeholders in Eye Care in India
  • International NGOs Service organizations
    in India
  • ORBIS International
  • CBM
  • OEU
  • Rotary International
  • International Eye Foundation
  • Sight Savers International
  • Lions Club International Foundation
  • HelpAge India

30
Role of Stakeholders in Eye Care in India
  • National Institutions/Agencies in India
  • Dr. R.P.Centre for Ophthalmic Sciences
  • ICMR
  • All IOL training centres
  • LVPEI
  • SN
  • AECS
  • AIOS
  • EBAI
  • VCS
  • SCEH

31
Strategic Opportunities
  • We do not present an exhaustive list, but present
    certain broad areas to stimulate discussion that
    may determine specific areas of interest for
    ORBIS-India.

32
Strategic Opportunities
  • Goals
  • Disease Control
  • Developing Human Resources
  • Strengthening Service Delivery
  • Promoting outreach activities and public
    awareness - advocacy
  • Develop institutional capacity, partnerships and
    Networking

33
Strategic Opportunities
  • Potential areas for interventions
  • Disease Control
  • Approaches
  • Research to understand risk factors and disease
    process better
  • Research to develop and improve service delivery
    models
  • Health economics

34
Disease Control
  • Cataract
  • Understand risk factors better, gender and
    socioeconomic factors
  • Alternate service delivery models

35
Disease Control
  • Cornea
  • Develop intervention for corneal abrasions at the
    primary level
  • Train ophthalmologists in Mgt of corneal
    infection
  • Develop a basic lab set-up
  • Study national need for corneas
  • Establish eye banks and accreditation process

36
Disease Control
  • Childhood blindness
  • Train Ophthalmologists and a team for pediatric
    eye care
  • Establish pediatric eye care units
  • Develop service delivery mechanism
  • School screening screening for school aged
    children
  • Research to understand causes and diseases better

37
Disease Control
  • Refractive errors
  • Develop service delivery models
  • Promote refraction training centres
  • Promote optical dispensing training centres
    (grinding, fitting)

38
Disease Control
  • Diabetic retinopathy
  • Strengthen tertiary care centres
  • Training in management of diabetic retinopathy
  • Awareness
  • Service delivery models

39
Disease Control
  • Glaucoma
  • Tertiary care centres
  • Training in management of glaucoma
  • Low Vision
  • Tertiary care centres
  • Training in management

40
Human Resource Development
  • MLOP
  • Develop curriculum
  • Training materials in regional languages
  • Body for accreditation
  • Develop Management Competence
  • Standardized Ophthalmologist training, CME

41
Service delivery models
  • Need to develop working models of primary eye
    care
  • Strengthen tertiary care models
  • Develop regionally appropriate IEC materials

42
  • Advocacy
  • Develop partner institutes to COE
  • Improve networking between stakeholders
  • Low Vision devices production

43
Technologies
  • Telemedicine
  • GIS
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